Mitchell Huang, MD, on the cost-effectiveness of transperineal vs transrectal prostate biopsy

The PREVENT trial (NCT04843566) previously showed that transperineal biopsy was associated with fewer infectious complications than transrectal biopsy. However, patients who underwent transperineal reported higher periprocedural pain (0.6 adjusted difference [0-10 scale]; 95% CI, 0.2 to 0.9).¹

A secondary analysis of the trial, which was presented at the 2025 American Urological Association Annual Meeting in Las Vegas, Nevada, compared the short-term cost-effectiveness of each approach.² In an interview with Urology Times®, lead author Mitchell M. Huang, MD, walked through the background and key findings from the analysis.

“The takeaway is that on a population level, on a health care system perspective, it's more cost-effective and safer to do transperineal prostate biopsy,” he said. “I think that helps to add additional texture [or] additional granularity to the data that we have from the original PREVENT trial.”

Huang is a PGY-4 resident at Northwestern University in Chicago, Illinois.

Specifically, data showed that transperineal prostate biopsy offered greater utility (+0.06 QALY per 1000 patients) and lower cost (-$63,170 per 1000 patients) compared with transrectal prostate biopsy. This finding was durable across the willingness-to-pay thresholds assessed, with 89% to 96% of simulations showing that transperineal biopsy was the more cost-effective option.

Further, the analysis showed that the per-patient cost to prevent a single infectious complication with transperineal biopsy was $3.98.

The authors also noted, “Notably, our analysis did not account for the long-term societal and economic cost of routine targeted prophylaxis, which may contribute to antibiotic resistance. This consideration likely further favors greater utilization of [transperineal] biopsy, as it completely avoids antibiotic prophylaxis.”

Based on these findings, Huang concluded, “Not only is [transperineal biopsy] safer for individual patients, but I think more broadly, on a population level, it's more cost-effective for the system.”

REFERENCES

1. Hu JC, Assel M, Allaf ME, et al. Transperineal versus transrectal magnetic resonance imaging-targeted and systematic prostate biopsy to prevent infectious complications: The PREVENT randomized trial. Eur Urol. 2024;86(1):61-68. doi:10.1016/j.eururo.2023.12.015

2. Huang MM, Driscoll CB, Handa N, et al. Cost-effectiveness of transperineal versus transrectal prostate biopsy: An economic analysis of the PREVENT trial. J Urol. 2025;213(5S):e1306. doi:10.1097/01.JU.0001110176.07507.51.06